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1、脑和脊髓的被膜、血管及脑脊液循环,兰州大学基础医学院 人体解剖学教研室,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,脑和脊髓的被膜、血管 及脑脊液循环,脑和脊髓的被膜 脑和脊髓的血管 脑脊液及其循环 脑屏障,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by Y
2、P HOU and YF SONG,脑和脊髓的被膜,脑和脊髓的表面有三层被膜，由外向内为：硬膜、蛛网膜、和软膜。起支持、保护脑和脊髓的作用。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,脊髓的被膜,由外向内依次为： 硬脊膜 脊髓蛛网膜 软脊膜,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All r
3、ight reserved by YP HOU and YF SONG,脊髓的被膜,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,硬脊膜（spinal dura mater） 由致密结缔组织构成，厚而坚韧，包裹着脊髓。 位置： 向上附于枕骨大孔边缘 向下在第二骶椎水平逐渐变细，包裹终丝下端附于尾骨,May, 2009,Copyright Depart. Anatomy, School of Medicine
4、, Lanzhou University. All right reserved by YP HOU and YF SONG,硬膜外隙：硬脊膜与椎管内面的骨膜之间的间隙。 间隙略呈负压，有脊神经根通过。 临床上常在此进行硬膜外麻醉。 硬膜下隙：硬脊膜和脊髓蛛网膜之间潜在的腔隙。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,脊髓蛛网膜（spinal arachnoid mater）为半透明的薄膜，在硬脊膜和
5、软脊膜之间向上与脑蛛网膜相延续。 蛛网膜下隙：脊髓蛛网膜和软脊膜之间较宽阔的间隙，内充满脑脊液。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,终池：脊髓蛛网膜下隙的下部，自脊髓下端马尾神经根部至第2骶椎水平扩大的马尾神经周围的蛛网膜下隙。 临床上常在第3、4或4、5腰椎间进行腰穿，此处不易伤及脊髓。,May, 2009,Copyright Depart. Anatomy, School of Medici
6、ne, Lanzhou University. All right reserved by YP HOU and YF SONG,软脊膜（spinal pia mater） 薄而富有血管，紧贴在脊髓的表面，在脊髓下端移行为终丝。 齿状韧带：脊神经前后跟之间形成的韧带，其尖端附于硬脊膜。作用： 保护脊髓：和脊神经根一起使脊髓固定在椎管内，并浸泡于脑脊液中，加上硬膜外隙内的脂肪组织和椎内静脉丛的弹性垫作用，使脊髓不因外界的震荡而损伤。 作为椎管内手术的标志。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou Unive
7、rsity. All right reserved by YP HOU and YF SONG,脑的被膜,由外向内依次为： 硬脑膜 脑蛛网膜 软脑膜,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,脑被膜模式图,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by Y
8、P HOU and YF SONG,硬脑膜（cerebral dura mater） 坚韧而有光泽，由两层合成，两层之间有血管和神经。 硬脑膜与颅盖骨连接疏松，硬脑膜损伤时易在两者之间形成硬膜外血肿。 硬脑膜在颅底处则与颅骨结合紧密，故颅底骨折时，易将硬脑膜与蛛网膜同时撕裂，导致脑脊液外漏。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,由硬脑膜形成的结构有： 大脑镰（cerebral falx）：呈镰刀形
9、伸入两侧大脑半球之间的大脑纵裂，前端连于鸡冠，后端连于小脑幕的顶，下缘游离于胼胝体的上方 小脑幕（tentorium of cerebellum）：形似幕帐，伸入大、小脑之间。位置： 后外侧缘附于枕骨横窦沟和颞骨岩部上缘,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,前内侧缘游离形成幕切迹，与鞍背之间形成一环形孔，称小脑幕裂孔，内有中脑通过。小脑幕将颅腔不完全分成上、下两部。 小脑镰（cerebellr f
10、alx）：自小脑幕下面正中伸入两小脑半球之间 鞍膈（diaphragma sellae）：位于蝶鞍上方，张于前床突、鞍结节和鞍背上缘之间，封闭垂体窝，中央有一小孔容垂体柄通过。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,硬脑膜窦（sinuses of dura mater）： 定义：硬脑膜在某些部位两层分开，内面衬以内皮细胞，形成了硬脑膜窦 特点：窦内含静脉血，窦壁无平滑肌，不能收缩，损伤时易形成颅内血
11、肿,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,主要的硬脑膜窦有： 上、下矢状窦 直窦 横窦 乙状窦 海绵窦 岩上窦和岩下窦,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,硬脑膜及硬脑膜静脉窦,May, 2009,Co
12、pyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,海绵窦,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,硬脑膜窦内血液的流向,上矢状窦 下矢状窦直窦窦汇横窦乙状窦 海绵窦岩上窦 岩下窦 颈内静脉,May, 2009,Copyright Depart
13、. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,脑蛛网膜（cerebral arachnoid mater）薄而透明，缺乏血管和神经，与硬脑膜之间有硬膜下隙，与软脑膜之间有蛛网膜下隙。脑蛛网膜下隙内充满着脑脊液 蛛网膜下池：蛛网膜下隙的大小不一，在有些部位扩大形成了蛛网膜下池,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserv
14、ed by YP HOU and YF SONG,小脑延髓池：小脑和延髓之间有，临床上常在此穿刺，进行脑脊液的检查 蛛网膜粒（arachnoid granulation）：脑蛛网膜紧贴硬脑膜，在上矢状窦处形成许多绒毛状突起，突入上矢状窦内,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,蛛网膜粒和硬脑膜窦,May, 2009,Copyright Depart. Anatomy, School of Medic
15、ine, Lanzhou University. All right reserved by YP HOU and YF SONG,软脑膜（cerebral pia mater）： 薄而富有血管和神经，覆盖于脑的表面并伸入沟裂内。 在脑室的一定部位，软脑膜参与构成脉络组织，其血管反复分支成丛，连同其表面的软脑膜和室管膜上皮一起突入脑室，形成脉络丛，脉络丛是产生脑脊液的主要结构。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and
16、 YF SONG,脑和脊髓的血管,脑的血管 脑的动脉：颈内动脉、椎动脉、大脑动脉环 脑的静脉：有浅组和深组之分 脊髓的血管 脊髓的动脉 脊髓的静脉,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,脑的血管,脑的动脉：来源于颈内动脉和椎动脉。 以顶枕沟为界： 颈内动脉供应大脑半球的前2/3和部分间脑 椎动脉供应大脑半球后1/3及部分间脑、脑干和小脑 因此脑的动脉可分为颈内动脉系和椎动脉系。两动脉系在大脑的分支为皮质支和中央支。,May, 2009,Copyright Depart. Anatomy, School of Medicine, Lanzhou University. All right reserved by YP HOU and YF SONG,脑底部的动脉,May, 2009,Copyright D
